Time to Initiation of Antihypertensive Therapy After Onset of Elevated Blood Pressure in Patients With Primary Proteinuric Disease

Abstract Rationale & objective To estimate the prevalence of hypertension in patients with proteinuric kidney disease and evaluate blood pressure (BP) control Study Design Retrospective Cohort study Setting & Participants Data from adults and children with proteinuric kidney disease enrolled in the multicenter Kidney Research Network registry were used for this study. Exposure Proteinuric kidney disease Outcomes Hypertension and BP control Analytical approach Patients with white coat hypertension were excluded. Patients were censored at end stage kidney disease onset. Patients were defined as hypertensive either by hypertension diagnosis code, having >2 encounters with elevated BPs, or treatment with antihypertensive therapy excluding renin-angiotensin-aldosterone-system blockade. Elevated BP was defined as >95th percentile for children and >140/90mmHg in adults. Sustained BP control was defined as >2 consecutive encounters with BPs Results 842 patients, 69% adults and 31% children, with a total observation period of 6722 patient-years were included in the analysis. 644 (76%) were hypertensive during observation. There was no difference in the prevalence of hypertension between children and adults (74% vs 78%, p=0.3). Hypertension was most common among those of African American race compared with other races (90% vs 72-75%, p=0.003). 504 (78%) hypertensive patients achieved BP control but only 51% achieved control within one year. 140 (22%) hypertensive patients never achieved BP control during a median of 41 (IQR: 24-73) months of observation. Limitations Differing BP control goals which may lead to overestimation of the controlled patient population Conclusions Hypertension affects the majority of proteinuric kidney disease patients regardless of age. Time to blood pressure control exceeded one year in 50% of the hypertensive patients and 22% did not demonstrate control. This study highlights the need to address hypertension early and completely in disease management of patients with proteinuric kidney disease.